Treatment and Monitoring After Surgery
Within a week to ten days after surgery you will see your surgeon for removal of stitches or staples. This is a relatively painless procedure.
A few weeks after surgery, your doctor will review the results of your final pathology report with you and give you the final diagnosis. The information from the pathology report helps the doctor to determine whether or not you need additional treatment, such as radioactive iodine (RAI).
For some patients, thyroid cancer treatment begins and ends with surgery. If the malignancy was small, removed by surgery and the patient has a low risk of recurrence, radioactive iodine may not be needed. In such case, the doctor will outline a schedule for future monitoring and will decide upon the recommended level of the patient's thyroid hormone replacement (taken by a daily pill).
Radioactive iodine treatment has two purposes:
- The first is to destroy any remaining normal thyroid tissue left behind from the surgery so that a unique protein, called Thyroglobulin (Tg), can be measured to indicate thyroid cancer recurrence in future blood tests. In some cases, even patients who have minimal disease have radioactive iodine treatment to facilitate post-treatment monitoring for recurrence.
- The second purpose of radioactive iodine treatment is to destroy any remaining thyroid cancer cells and minimize the risk of recurrence. As many thyroid cancer patients are young adults, the issue of radioactive iodine and fertility is a common concern. Thousands of couples have had successful pregnancies after receiving radioactive iodine treatment. If you are planning a family, or planning to add to your family, consult your doctor for advice about the safe scheduling of treatment and pregnancy. For more information on this topic see Thyroid Cancer, Fertility and Pregnancy on the Thry'vors website www.thryvors.org.
Radioactive Iodine Treatment
Where radioactive iodine (RAI) treatment is recommended, its purpose is to ablate (destroy) any remaining thyroid tissue, and to reduce the risk of recurrence. A treatment dose is usually in the range of 3.7-5.5 GBq (100 or 150mCi), but can vary based on the size of the initial tumour and other risk factors. The RAI treatment may occur anytime from six weeks to six months post-surgery. Another approach is to closely follow patients in the post-surgery months using ultrasound and blood tests, keeping the radioactive iodine treatment an option if the test results indicate its necessity.
"Going Hypo"
Our bodies require thyroid hormone; a hormone taken in synthetic form once the thyroid has been removed. Without thyroid hormone, the body produces an increasing amount of thyroid stimulating hormone (TSH). An elevated TSH of at least 30 mIU/L is needed for the RAI treatment to be effective. To achieve this rise in TSH, patients must stop taking their thyroid hormone replacement pills, or have their TSH stimulated by taking Thyrogen®, a medication given by injection (see section below). Going hypothyroid by hormone withdrawal, involves stopping levothyroxine, also known as T4 (brand names are Synthroid and Eltroxin) for approximately 4-6 weeks prior to RAI treatment. During the time that levothyroxine is stopped, Cytomel (T3) may be prescribed. Cytomel is a fast-acting (and fast dissipating) form of thyroid hormone used to minimize the symptoms of hypothyroidism during hormone withdrawal. Cytomel is stopped approximately 2 weeks prior to RAI treatment. 'Going hypo' is a gradual process with the thyroid hormone changes occurring slowly over the six week period. The longer the patient is off of thyroid hormone, especially during the last two weeks prior to RAI treatment when no thyroid hormone is taken, the more likely the patient will experience symptoms of hypothyroidism.
Some Symptoms Associated with Hypothyroidism:
- Tiredness, loss of energy, weakness
- Trouble sleeping, nightmares or excess sleep
- Puffiness and bloating especially in the face
- Loss of ability to concentrate, memory loss, absentmindedness
- Weight gain
- Anxiety, panic attacks, irritability, mood swings
- Depression
- Dry eyes, skin and hair; hair loss
- Change in menstrual cycle
- Joint pains and stiffness, muscle cramps
- Intolerance to cold
- Constipation
- Tingle or numbness in arms or legs
- Ringing in ears
- Slight changes in eyesight
Helpful Hints for "Going Hypo" and Preparing for RAI
- Identify people you can count on for support and help before and after your treatment.
- Obtain information from your Nuclear Medicine department or doctor regarding precautions and preparation for your return home from the hospital. Make sure your family and friends understand the necessary precautions.
- Consult with your doctor about your daily activities including driving, and learn when you should restrict your activities. (Note that hypothyroidism is a form of physical impairment, thereby restricting you from driving in the final days or weeks before treatment.)
- Prepare low iodine diet (LID) menus and have your pantry stocked with low iodine foods (see LID section).
- Take naps as needed.
- Watch alcohol consumption while hypo as the impact will be much greater than what you normally experience.
- Keep your sense of humour.
- Don't expect immediate recovery right after your scan is complete. While patients feel much better in 2-3 weeks, it takes approximately 8 weeks for the thyroid hormone levels to normalize once thyroid hormone pills are resumed.
Disclaimer: The information contained on this website does not constitute medical advice. Visitors are encouraged to work closely with their doctors to make sure that their individual medical needs are met. The Canadian Thyroid Cancer Support Group (Thry'vors) Inc. does not endorse any product, treatment, service or practitioner and is not responsible for the quality of the information or services offered by other organizations or websites.
© Canadian Thyroid Cancer Support Group (Thry'vors) Inc.